Dr. Jessica Wells, RN, PhD is a Research Assistant Professor at Emory University Nell Hodgson Woodruff School of Nursing working under the mentorship of Drs. Deborah Watkins Bruner, RN, PhD, FAAN, Marcia M. Holstad, FNP, PhD, FAAN, and Hannah Cooper, ScD. Her long-term career goal is to be an independent investigator and leader at the forefront of cancer and HIV research. Her previous research training through her pre-doctoral NRSA award provided scientific knowledge and skills in research design, implementation, and basic statistical methods related to cancer research. This K01 career development award will provide an opportunity to merge and expand her cancer research training to the HIV population. Under the guidance of her mentorship team, a training and research development plan was created to facilitate attainment of her career development goals and competencies. Her career development goals include: 1) develop knowledge and skills in performing cancer research in the HIV population; and 2) gain advance statistical skills in multilevel modeling and GIS analysis; and 3) enhance and refine research skills and program of research to position career as an independent and successful investigator. At the end of this award period, Dr. Wells aims to be uniquely trained with sought after skills that integrate cancer science and HIV science with in-depth experience in advanced methodology such as multi-level analysis and geo-spatial analysis. To take a first step toward these goals, the current study will examine the individual-, interpersonal-, neighborhood-level factors that best fit a model to predict adherence to follow-up high-resolution anoscopy after an abnormal anal Papanicolaou (Pap) cytology in this population. HIV-infected persons are 28 times more likely to be diagnosed with anal cancer than the general population. Without active intervention, the incidence of anal cancer will continue to grow among HIV-infected individuals especially with the growth and aging of this population. Therefore, timely anoscopy follow up after an abnormal anal Pap test is imperative for a successful cancer prevention plan. The specific aims of the proposed study are: (1) to build a model of individual-level (depression, HIV-related stigma, health beliefs, substance/drug abuse) and interpersonal-level (social support and marital or partner status) factors related to adherence to follow up anoscopy, and (2) as an exploratory aim, we will examine the extent to which neighborhood-level factors (% poverty and racial/ethnic composition) are 2a) are related to adherence to follow up anoscopy, and if they are related, 2b) we develop a model of individual-, interpersonal-, and neighborhood level factors that best predict adherence to anoscopy follow up after an abnormal anal Pap test. Multilevel analysis is a timely and innovative approach to examine risk factors related to adherence to high resolution anoscopy. Findings from this study will be used to develop innovative strategies that address multilevel risk factors and inform interventions that will meet the laudable goal of reducing the personal and clinical burden associated with anal cancer in individuals living with HIV.